TRICARE Claims Review Services (TCRS)

TITLE: Government’s Notice of extension of the TRICARE Claims Review Services (TCRS) contract performed by Concept Plus for up to 12 months. The work includes evaluating the accuracy of claims payment and payment record coding under the terms of the TRICARE Claims Review Services contract.

INTRODUCTION: The Defense Health Agency (DHA), DHA Contracting Activity (DHACA), Managed Care Contracting Division (MC-CD), is issuing this Sources Sought Notice pursuant to Defense Federal Acquisition Regulation Supplement (DFARS) 206.302-1, only one responsible source and no other supplies or services will satisfy agency requirements. The DHA intends to issue a sole-source bridge action to continue the provision of services provided under the existing TCRS contract, HT9402-17-D-0001, to Concept Plus. This contract modification to extend performance is necessary to continue to meet mission critical requirements and to support the transition to a competitively awarded follow-on TCRS contract.

The base period of performance will be from March 01, 2023 - August 31, 2023, with an option to extend services, using FAR 52.217-8, for up to an additional 6 months. The total potential period of performance is March 01, 2022 - February 28, 2023. The extension is necessary to prevent a gap in support to critical DHA requirements after the end of the current TCRS contract on February 28, 2022, until a competitive follow-on contract is awarded, and the awardee completes transition-in.

Background:  The Defense Health Agency (DHA) supports health services for more than 9.4 million beneficiaries of the Military Health System (MHS). The purpose of the TCRS contract is to assist the DHA Improper Payment Evaluation Branch (IPEB) in identifying and reporting improper payments and discrepancies in payment recording for the MHS. TCRS support provides an independent impartial review of claims processing procedures and reimbursement methodologies utilized by purchased-care contractors and assesses purchased-care contractor compliance with TRICARE policies and directives by evaluating the accuracy of claims payment and payment record coding for the MCSC, TMEP, TPharm, TOP, and ADDP contracts. TCRS helps support IBEP’s requirement to assess the potential risk of improper payments and to identify and report improper payments to the Office of Management and Budget (OMB) for publication in the Department of Defense (DoD) Agency Financial Report (AFR) pursuant to Public Laws 107-300, and the Payment Integrity Act of 2019 (PIIA), Public Laws 116-117.

A new contractor would require a minimum of 6 months to complete the transition-in requirements given the startup requirements associated with staff recruiting and training, meeting the Personnel Security, and System Security and connectivity requirements. The current TCRS contractor, Concept Plus, is the only known contractor that can provide these services within the needed time frame.

AUTHORITY: The Defense Health Agency (DHA), DHA Contracting Activity (DHACA), Managed Care Contracting Division (MC-CD) is issuing this Special Notice Request for Information for the purpose of Market Research as required by the Federal Acquisition Regulation (FAR) 15.201 and FAR Part 10 for issuing a sole-source bridge action per Defense Federal Acquisition Regulation Supplement (DFARS) 206.302-1.

DISCLAIMER AND IMPORTANT NOTES: THIS NOTICE IS NOT A REQUEST FOR PROPOSALS. Any proposals submitted will not receive a response. This notice solely constitutes a market research effort, for informational purposes only, as described under FAR 10.002. This notice does not obligate the Government to award a potential contract or otherwise pay for the information provided in response. Responses to this RFI are not offers and cannot be accepted by the Government to form a binding contract. The Government reserves the right to use results of the communications with industry for any purpose consistent with, and not otherwise prohibited by FAR Part 10.

NEXT STEPS: Interested parties with information to share must make their submittals to the Government via email to the Primary Point of Contact (below) not later than 2pm Mountain Standard Time (MST) on December 12, 2022. Any organization responding to this notice should ensure that its response is complete and sufficiently detailed to allow the Government to determine the organization’s qualifications to perform the work.

PRIMARY POINT OF CONTACT: Please respond or submit inquiries (via email) to the Defense Health Agency, Managed Care - Contracting Division, TRICARE Support Branch, through Ms. Rachel Beckett at rachel.j.beckett.ctr@health.mil. Respondents are advised that the Government is under no obligation to acknowledge receipt of the information received or provide feedback to respondents with respect to any information submitted.

CONFIDENTIALITY: No proprietary, classified, confidential, or sensitive information should be included in your response. Industry responses will be shared with DHA staff for the purpose of market research. The Government reserves the right to use any non-proprietary technical information in any resultant solicitation(s).

ADMINISTRATIVE:

PSC Code: R408 Program Management/Support Services

NAICS Code: 541611 - Administrative Management and General Management Consulting Services